Depression

A Depression Study Yields Surprises

Several years ago, Harold "Woody" Neighbors undertook a qualitative study of depression among black men in four urban settings
in the U.S.—Detroit, Raleigh, Atlanta, and Baltimore. The study, called "Man Up, Man
Down" (drawn from the phrase "man up," meaning "don't complain—just handle your business"),
consisted primarily of focus groups in which participants examined their understanding
and experience of and with depression.

Findings from the research were striking, says Neighbors, a professor of health behavior
and health education and associate director of the U-M Center for Research on Ethnicity, Culture and Health. Not only did Neighbors and his team encounter few problems in enrolling men for
the focus groups, but at the end of the study, many participants expressed a desire
for the focus groups to continue. "We'd worried about stigma," Neighbors recalls,
"but these men didn't mind coming into this kind of setting, sitting around a table
with six to seven other guys, and talking."

Inspired by his findings, Neighbors immediately sought funding to create a pilot intervention
program to address depression among African-American men in Detroit. In partnership
with the Detroit Recovery Project and its CEO, André Johnson, Neighbors and his research
team are now embarking on that study—an eight-week series of weekly support groups
in which participants discuss depression and its impact. Discussion topics include
terminology and definitions, symptoms, treatment options, masculinity, social isolation,
and issues such as anger and its role in depression.

As interventions go, says Neighbors, "it's not very expensive. So if we can obtain
evidence that the program is a cost-effective way of helping black men feel better,
we plan to replicate it in different community centers throughout Detroit."

From the Depths of Despair, a Public Health Breakthrough

After the death of his daughter Julia in 2010, Victor Strecher "essentially lost my own purpose in life," as he puts it. In an effort to transcend
his grief, he began reading what other thinkers—ancient philosophers as well as modern
scientists—had to say about purpose. One of those was the Austrian neurologist and
psychiatrist Victor Frankl, whose Man's Search for Meaning recounts Frankl's experience as a Holocaust survivor and outlines his concept of
"logo" or "meaning" therapy. Strecher found Frankl's approach inspiring. "In most
therapy, the focus is typically on the person needing the therapy, whereas in logotherapy,
the focus is on 'how can I do something bigger than myself?'"

Strecher seized the idea and ran with it. In his own book, On Purpose: Lessons in Life and Health from the Frog, the Dung Beetle, and Julia, published in 2013, he traces his journey from numb grief to a new understanding
of health. "I felt like I was running into a wall with the approaches we were taking
in our field," Strecher says. "We weren't explaining much more than 30 percent of
variance in human behavior. I'm now focused more on the deep motivation that stimulates
big quantum change in people."

Among its unconventional cast of characters, the book features Strecher and his family,
a classful of SPH students, the Grim Reaper, and an insightful dung beetle named Winston.
A free companion app allows readers to chart and track daily progress on their own
life's mission. For more, visit dungbeetle.org.

Man Down

While he was developing "Man Up, Man Down," an intervention aimed, in part, at helping
African-American men address the stigma associated with depression, Harold "Woody" Neighbors became a "man down" himself. Unmoored by the death of his daughter Kamilah (MPH '01)
in 2010, Neighbors "felt down and out—totally devastated," as he puts it. "At first
I didn't think I needed help. But I couldn't deny my symptoms. I began asking myself,
'Who can I talk to? Where do I go for help? More importantly, how do I start to reveal
to other people that I'm in trouble here?'"

As a researcher, he found himself in the curious position of living the "Man Up, Man
Down" experience while listening to other black men talk about their experiences with
depression. Neighbors drew strength from his own intervention, as well as from family
and friends. He also got professional help. "My story has an optimistic, positive
end to it," he says. "I am still profoundly sad, but I am also stronger in some ways."

The overall experience deepened his commitment to his research. "This work is so much
about taking the very private experience of emotional pain and making it public, which
makes it social in addition to being personal," he says. "This is a great way for
men to get the help we deserve. It is unhealthy for us to 'man up' to everything.
It's also the way for men to change our characterization as hard-to-reach and underserved."

Mobile Health Technology in Bolivia

Few resources exist in low- and middle–income countries to help people with depression.
But John Piette, co-director of the U-M Center for Managing Chronic Disease, and Mary Janevic, assistant research scientist, are using mobile-health interventions, including an
"Interactive Voice Response" telephone system, to provide both self-care support to
people with depression and feedback about patients' needs to community health workers.
Piette and Janevic are currently working with SPH students to introduce this new health
technology in Bolivia.

By enabling people to self-monitor and treat their condition through weekly calls
and health education programs, Piette and Janevic hope to improve access to care within
given communities. In the long term, they hope to expand the program to other low-
and middle-income countries in Latin America. One lesson Piette and Janevic have learned
is that community members are invaluable partners. Piette says, "Local organizations
are doing things with community health workers that students and faculty can really
learn from and use to improve access to care for vulnerable communities in the U.S."—Rachel Ruderman

Genetic and Other Causes of Depression in the First-Year Medical Residency

Burnout and depression are commonplace among medical school graduates during their
first year as resident physicians. Working long and stressful shifts—which often come
with little sleep, numerous patient handoffs, and heightened potential for medical
error—about a third of residents report significant increases in symptoms of depression.

Although many stress-related risk factors have been identified for depression, researchers
have found it difficult to identify genetic variants that increase individual risk,
perhaps due to the wide variety of stress-related risk factors associated with the
disease. Because medical interns are a relatively homogeneous group who come face-to-face
with a small set of strong stressors, Srijan Sen, an assistant professor in the U-M
Molecular & Behavioral Neuroscience Institute; Laura Scott, an associate research professor in biostatistics and the U-M Center for Statistical Genetics; and Peter Song, a professor in biostatistics, have begun collecting and analzying data from more
than 5,000 first-year medical interns. The scientists hope their study will lead to
a deeper understanding of stress and its links to depression.

In the study's next phase, Scott says, the researchers will look across the genome
to identify sites where variation between individuals is associated with differences
in the risk of depression. "Our hope is that by looking for genetic variants that
influence risk in the presence of these strong stressors we will have a better chance
to understand their interaction with stress," says Scott. "The identification of these
variants may eventually drive drug development and ultimately improve the lives of
those at risk for experiencing the disorder." —Nora White